Infantile hemangioma is the most common benign tumor in infancy (4-10%) (1). It is generally absent at birth and is characterized by a stereotypical evolution in 3 phases (2): a phase of rapid growth (mainly the first 3 months but which can extend up to 6-9 months), a phase of stagnation followed by involution for several years. The regression is marked by a whitening of the superficial lesions and a sagging of the deep components, but scars can still persist. Most hemangiomas are self-limited but 10-15 % of them cause complications like ulcerations, necrosis or cosmetic disfigurement. Some can be life-threatening because of specific localisation like subglottic or multifocal with visceral involvement. In 2008, the treatment of infantile hemangioma has undergone a revolution thanks to the discovery of the effectiveness of propranolol, a non selective ß-adrenergic receptor-blocking agent, which has become the first-line therapy in complicated hemangiomas. (3) In those cases, treatment with propranolol should be started between 5 weeks and 5 months of life (proliferative phase of growth) at a rate of 3 mg /kg /day in 2 divided doses.
The pretreatment assessment includes a complete clinical examination (including especially blood pressure, heart rate and a pulmonary auscultation), a blood test with hepatic, renal and glycemia assessment and an electrocardiogram to exclude a first degree atrioventricular block.(4) The initiation of treatment and dose increases are carried out either in a specialized hospital or in a day hospital. The initial administration is started at 1 mg/kg/day with a 4 hours cardio-respiratory monitoring (heart rate, blood pressure, respiratory rate). Treatment should be continued until the age of 1 year old. The most serious side effects are hypoglycemia, bradycardia, hypotension and bronchospasm. Sleep disturbances, irritability and cold extremities are also reported. (5)
1. Munden A et al. Br J Dermatol. 2014;170(4):907-913
2. Luu M et al. Br J Derm. 2013;169:20-30
3. Léauté-Labrèze C. et al. N Engl J Med. 2008;358(24):2649-2651
4. Delmotte N et al. Thérapie 2012 Mai-Juin; 67 (3):257–265
5. Léauté-Labrèze C. Pediatrics. 2016; 138(4):e20160353
Dr. Déborah Salik, Dr. Chantal Dangoisse (ULB)